Myung Karen S, Glassman David M, Tolo Vernon T, Skaggs David L
*Children's Orthopaedic Center, Children's Hospital Los Angeles, Los Angeles, CA †Naval Medical Center Portsmouth, Portsmouth, VA.
J Pediatr Orthop. 2014 Jan;34(1):29-33. doi: 10.1097/BPO.0b013e31829b2d75.
To examine the surgical site infection (SSI) rates in patients undergoing posterior spinal fusion surgery for adolescent idiopathic scoliosis (AIS) after implementation of a change in antibiotic prophylaxis and intraoperative irrigation.
A retrospective review of all consecutive spinal fusions for AIS from 1996 to 2008 was performed. In 2003, 2 changes in our protocol were implemented: (1) routine antibiotic prophylaxis was changed from cefazolin alone to vancomycin and ceftazidime; (2) intraoperative irrigation technique was changed from bulb syringe to pulse lavage irrigation. We compared the rates of deep SSI requiring irrigation and debridement before institution of these changes (1996 to 2002) to the rates after these changes (2003 to 2008).
Before the change in the antibiotic and lavage regimen, 261 spinal fusions were performed. Of these, 28/261 (11%) patients underwent irrigation and debridement for SSI. The most common infecting pathogen was coagulase-negative Staphylococcus aureus (47%). Between the years 2003 and 2008, 263 spinal fusions were performed. Only 2/263 (0.7%) patients underwent irrigation and debridement for SSI. This decrease in infection rate is highly significant (P<0.001).
Routine use of vancomycin and ceftazidime and pulsatile lavage for posterior spinal fusion in AIS patients decreased the rates of postoperative infection by 10 fold. As 2 variables were changed, it is impossible to know the relative effect of each. However, as spine infections can be so devastating, and the potential risks of these changes are small, we recommend both the new antibiotic and irrigation protocol.
Level III.
在实施抗生素预防措施及术中冲洗方法改变后，研究接受后路脊柱融合手术治疗青少年特发性脊柱侧凸（AIS）患者的手术部位感染（SSI）发生率。
对1996年至2008年期间所有连续进行的AIS脊柱融合手术进行回顾性研究。2003年，我们的方案实施了两项改变：（1）常规抗生素预防从仅使用头孢唑林改为万古霉素和头孢他啶；（2）术中冲洗技术从球囊注射器冲洗改为脉冲冲洗。我们比较了这些改变实施前（1996年至2002年）需要冲洗和清创的深部SSI发生率与改变后（2003年至2008年）的发生率。
在抗生素和冲洗方案改变之前，进行了261例脊柱融合手术。其中，28/261（11%）例患者因SSI接受了冲洗和清创。最常见的感染病原体是凝固酶阴性金黄色葡萄球菌（47%）。在2003年至2008年期间，进行了263例脊柱融合手术。只有2/263（0.7%）例患者因SSI接受了冲洗和清创。感染率的这种下降具有高度统计学意义（P<0.001）。
在AIS患者后路脊柱融合手术中常规使用万古霉素和头孢他啶以及脉冲冲洗使术后感染率降低了10倍。由于改变了两个变量，无法知道每个变量的相对作用。然而，由于脊柱感染可能具有极大的破坏性，且这些改变的潜在风险较小，我们推荐新的抗生素和冲洗方案。
三级。
